Healthcare Provider Details

I. General information

NPI: 1376379248
Provider Name (Legal Business Name): FOLSOM PHYSICAL THERAPY & TRAINING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NATOMA ST
FOLSOM CA
95630-2615
US

IV. Provider business mailing address

115 NATOMA ST
FOLSOM CA
95630-2615
US

V. Phone/Fax

Practice location:
  • Phone: 916-355-8500
  • Fax:
Mailing address:
  • Phone: 916-355-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J MOORE
Title or Position: PRESIDENT
Credential: RPT
Phone: 916-355-8500